Relationship of disease characteristics and nutritional status to patterns of growth in children with Crohn disease

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Abstract
Crohn disease is one type of inflammatory bowel disease with frequent occurrence before maturity. Many children with Crohn disease experience linear growth retardation. However, the prevalence and contribution of various factors to growth failure have not been adequately investigated. The purpose of the present study was to estimate the prevalence of growth deficiency by using multiple criteria based on longitudinal data and to simulatneously evaluate the contribution of disease, demographic, and treatment characteristics to the growth failure in this group of children. A sample of 78 patients assessed retrospectively and 41 patients followed prospectively were drawn from the Children's Hospital of Philadelphia Division of Gastroenterology and Nutrition. Data on growth, nutritional status (hematocrit and albumin levels), disease characteristics (severity, site, duration, and age of onset), and steroid dosage were collected for both groups. For the prospective sample, measurements of height, weight, and four skinfold thicknesses were taken. A 24 hour recall and 3 day food record estimated kcal intake. Parental size was taken by report from the accompanying caregiver. When three criteria were used, prevalence of growth retardation was 67% in the retrospective group, higher than most available figures. In the prospective sample, reductions in height adjusted for midparental size were greater than those for weight, and depletion of lower body fat was greater than that of upper body fat. Multiple regression analyses showed that degree of growth retardation as measured by the parent adjusted z score for height was associated with higher steroid dosage and later age of disease onset, but not disease severity or the anatomical site of the disease. Of the nutritional status variables, degree of growth retardation was most closely associated with degree of reduction in lower body fat stores.